Provider Demographics
NPI:1770591018
Name:CURTIS, JENNIFER L (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WARRENTON WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7247
Mailing Address - Country:US
Mailing Address - Phone:864-238-5090
Mailing Address - Fax:
Practice Address - Street 1:151 WARRENTON WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7247
Practice Address - Country:US
Practice Address - Phone:864-238-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist